Ethical Implementation of Organ Donation Following Medical Assistance in Dying: Recommendations of the Ethics Committee of the Transplantation Society

Background. – Medical assistance in dying (MAiD) is legally permitted in a growing number of jurisdictions, and in 6, it can currently be followed by organ donation. Organ donation following MAiD offers patients an opportunity to address transplant needs as a final act of altruism, but it also raises complex ethical questions that require strong safeguards to protect patients, professionals, and public trust. Methods. – We identified key ethical issues and safeguards by analyzing guidelines and protocols from the 6 countries where organ donation following MAiD is performed: Australia, Belgium, Canada, the Netherlands, New Zealand, and Spain. This article was developed under the auspices of the Ethics Committee of The Transplantation Society with medical, ethical, and legal experts from these countries. Results. – Three domains of ethical concern emerged: (1) safeguarding the integrity of patients’ decision-making (voluntariness, informed consent, and how and when information is presented); (2) ethical governance of donation following MAiD (adherence to the Dead Donor Rule, death determination, and consent for premortem interventions); and (3) implications for care relationships and professional practice (end-of-life impacts, recipient information and donor anonymity, and professional support, including conscientious objection). Key recommendations include clear and consistent policies; a patient-centered, nondirective approach; rigorous eligibility and voluntariness assessments; and strict separation between MAiD and donation/transplantation teams. Conclusions. – These recommendations provide practical guidance for implementing organ donation following MAiD in jurisdictions where it is practiced or being considered. They support patients’ end-of-life wishes while safeguarding ethical and legal standards and maintaining trust in both MAiD and organ transplantation.